The patient with functional disease/malingering

  • Gunnar B. J. Andersson
  • Thomas W. McNeill


The problem of the perception of pain, the patient’s potential advantages in having others perceive him as being the “victim” of a painful condition, and the inability of the physician to validly measure pain cause most examining physicians to delay the proper diagnosis of “psychogenic pain” and/or “central pain” to the potential detriment of all concerned. The detriment comes from the repetitive and redundant search for a nonexistent somatic cause for the pain and the institution of different unsuccessful treatments. In order for the physician to clearly understand the problem of functional disease and/or malingering it is essential to understand some basic modern concepts of pain, it is transmission, perception, and clinical presentation. In general, this was discussed in Chap. 1, and should be reviewed before reading further into this chapter.


Pain Behavior Conversion Hysteria Minnesota MUltiphasic Personality Inventory Pain Complaint Somatization Disorder 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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  1. Chapman CR, Bonica JJ (1983) Current concepts: acute pain. Upjohn Publications, Kalamazoo, MIGoogle Scholar
  2. Deyo RA, Diehl AK (1986) History predictive of low back pain disabilities. Presented at the Am Rheumatism Assoc and Arthritis Health Prof Assoc Annual Meeting, New OrleansGoogle Scholar
  3. Engel GL (1983) Pain. In: Blacklow RS (ed) MacBryde’s signs and symptoms, 6th edn. Lippincott, Philadelphia, pp 41–60Google Scholar
  4. Gatchel RJ, Mayer TG, Capra P, Diamond MA, Barnett MA (1986) The utility of the Million Behavioral Health Inventory in predicting physical function in low back pain patients. Presented at the 13th Annual Meeting Int Soc Study of the Lumbar Spine, Dallas, TXGoogle Scholar
  5. Hendler N, Mollett A, Viernstein M, Schroeder D, Rybock J, Campbell J, Levin S, Long D (1985) A comparison between the MMPI and the “Hendler Back Pain Test” for validating the complaint of chronic back pain in men. J Neurol Orthop Med Surg 6: 333–337Google Scholar
  6. Leavitt F (1985) Pain and deception: use of verbal pain measurement as a diagnostic aid if differentiating between clinical and simulated low-back pain. J Psychosom Res 29: 495–505PubMedCrossRefGoogle Scholar
  7. Leavitt F, Garron DC (1979) Validity of a back pain classification scale among patients with low back pain not associated with demonstratable organic disease. J Psychosom Res 23: 301–306PubMedCrossRefGoogle Scholar
  8. Leavitt F, Sweet JJ (1986) Characteristics and frequency of malingering among patients with low back pain. Pain 25: 357–364PubMedCrossRefGoogle Scholar
  9. Maciewicz R, Sandrew BB (1985) Physiology of pain. In: Aronoff GM (ed) Evaluation and treatment of chronic pain. Urban & Schwarzenberg, Baltimore Munich, p 17 ffGoogle Scholar
  10. Melzack R (1975) The McGill pain questionnaire: major properties and scoring methods. Pain 1: 277–299PubMedCrossRefGoogle Scholar
  11. Melzack R, Wall PD (1965) Pain mechanisms: a new theory. Science 154: 971–979CrossRefGoogle Scholar
  12. McNeill TW, Sinkora G, Leavitt F (1986) Psychologic classification of low-back pain patients: a prognostic tool. Spine 11: 955–959PubMedCrossRefGoogle Scholar
  13. Snyder SH (1986) Drugs and the brain. Scientific American Library, WH Freeman and Co, New York OxfordGoogle Scholar
  14. Smith RG, Monson RA, Ray DC (1986) Psychiatric consultation in somatization disorder: a randomized controller study. N Engl J Med 314: 1407–1413PubMedCrossRefGoogle Scholar
  15. Waddell G, Mann TS (1985) Medico-legal factors in low back pain. Abstracts of papers, Annual Meeting Int Soc Study of the Lumbar Spine, Sydney, 12: 139Google Scholar
  16. Waddell G, McCulloch JA, Kummell EG, Venner RM (1980) Nonorganic physical findings in low back pain. Spine 5: 117–125PubMedCrossRefGoogle Scholar
  17. Waddell G, Main CJ, Morris EW, Di Paola M, Gray ICM (1984) Chronic low-back pain, psychologic distress, and illness behavior. Spine 9: 209–213PubMedCrossRefGoogle Scholar
  18. Ward NG (1986) Tricyclic antidepressants for chronic low-back pain. Spine 11: 661665Google Scholar
  19. Weintraub MI (1977) Hysteria: a guide to diagnosis. Clin Symp 29: 2–31Google Scholar

Copyright information

© Springer-Verlag/Wien 1989

Authors and Affiliations

  • Gunnar B. J. Andersson
    • 1
  • Thomas W. McNeill
    • 1
  1. 1.Department of Orthopedic SurgeryRush-Presbyterian-St. Luke’s Medical HospitalChicagoUSA

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